title: Validation of automatic bone age determination in children with congenital adrenal hyperplasia.
abstract: BACKGROUND
  Determination of bone age is routinely used for following up substitution therapy in congenital adrenal hyperplasia (CAH) but today is a procedure with significant subjectivity.
  
  
  OBJECTIVE
  The aim was to test the performance of automatic bone age rating by the BoneXpert software package in all radiographs of children with CAH seen at our clinic from 1975 to 2006.
  
  
  METHODS
  Eight hundred and ninety-two left-hand radiographs from 100 children aged 0 to 17 years were presented to a human rater and BoneXpert for bone age rating. Images where ratings differed by more than 1.5 years were each rerated by four human raters.
  
  
  RESULTS
  Rerating was necessary in 20 images and the rerating result was closer to the BoneXpert result than to the original manual rating in 18/20 (90 %). Bone age rating precision based on the smoothness of longitudinal curves comprising a total of 327 data triplets spanning less than 1.7 years showed BoneXpert to be more precise (P<0.001).
  
  
  CONCLUSIONS
  BoneXpert performs reliable bone age ratings in children with CAH.
authors.affiliation: Pediatric Endocrinology and Diabetology, University Children's Hospital, Hoppe-Seyler Strasse 1, 72076, Tuebingen, Germany, david.martin@med.uni-tuebingen.de.
authors.forename: David D
authors.initials: DD
authors.lastname: Martin
authors.forename: Katharina
authors.initials: K
authors.lastname: Heil
authors.forename: Conrad
authors.initials: C
authors.lastname: Heckmann
authors.forename: Angelika
authors.initials: A
authors.lastname: Zierl
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schaefer
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ranke
authors.forename: Gerhard
authors.initials: G
authors.lastname: Binder
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000000981:diagnostic imaging*; D000365:Age Determination by Skeleton / Q000379:methods*; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005260:Female; D050276:Hand Bones / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D012986:Software Validation